Analysis of Healthcare Finance and Revenue Cycle Management
Examine the reimbursement processes of different health insurance plans.
|Domain IV. Revenue Management||Subdomain IV. A. Revenue Cycle and Reimbursement||3. Apply principles of healthcare finance for revenue management|
|Domain IV. Revenue Management||Subdomain IV. A. Revenue Cycle and Reimbursement||4. Implement processes for revenue cycle management and reporting|
|Domain V. Compliance||Subdomain V.B. Coding||3. Identify the severity of illness and its impact on healthcare payment systems|
|Domain VI. Leadership||Subdomain VI.F. Strategic and Organizational Management||5. Identify the different types of organizations, services, and personnel and their interrelationships across the health care delivery system|
Imagine that you are an administrator for a large hospital. As part of your role within healthcare leadership, you are involved in several committees for the organization. Please follow the instructions below in the completion of this multi-part assignment.
|1||Apply principles of healthcare finance for revenue management.||Imagine that you are the Chief Information Officer (CIO) for a multi-hospital health system. You are requesting funding from the Board of Directors for an investment of a new electronic health record (EHR) system. In preparation for your funding request, you have scheduled a meeting with the department managers. In this meeting, you will demonstrate the principles of healthcare finance for revenue management through the intended application of cost reporting and variances. Compose an executive summary for your team covering those topics with budget speculation.|
|2||Implement processes for revenue cycle management and reporting.||Knowing that the Board of Directors will need to consider the implications of adopting a new EHR system on the information systems related to RCM and reporting, you will analyze three (3) major considerations on Corrective Coding Initiative (CCI)-Electronic Billing X12N, compliance strategies and reporting, audit process (compliance and reimbursement), revenue cycle process, and/or utilization and resource management. Include your analysis within the executive summary.|
|3||Identify severity of illness and its impact on healthcare payment systems.||As part of your analysis on the implications of a new EHR system on other information systems, analyze the relationship between data quality within a new EHR and severity of illness. Identify the purpose and use of severity of illness based on information within the health record. Conclude your analysis by associating severity of illness and healthcare payment systems. Please make sure to integrate case-mix and CAC systems.|
|4||Identify the different types of organizations, services, and personnel and their interrelationships across the health care delivery system.||As CIO, you understand that your executive report will likely become available to the general public–either on its own or when combined into another report. Demonstrate the connections among the different types of organizations, services, and personnel–including their interrelationships across the health care delivery system–by analyzing the implications of a new EHR system with the hospital systems’ operations with ACOs and MCOs. Additionally, include the implications related to medical devices / biotechnology.|